Endoscopic devices commonly used to harvest vein grafts for coronary artery bypass surgery may result in poorer outcomes than traditional vein harvesting techniques, revealed by researchers.
The new study published in the New England Journal of Medicine by researchers at Duke University Medical Center.
In the largest and longest study conducted to date, researchers found that patients who underwent endoscopic removal of the healthy veins needed for coronary bypass surgery were 22 percent more likely to require another surgery, have a heart attack, or die compared to patients who underwent an older, more invasive procedure.
“Because of real short-term benefits, endoscopic vein harvesting devices have been widely accepted in clinical practice,” said John Alexander, MD, senior author of the study and a cardiologist at the Duke Clinical Research Institute.
“However, prior to this study, no one had looked at the long-term outcomes associated with their use. The changes we observed were relatively infrequent and didn’t become apparent until a year after the CABG (coronary artery bypass graft) surgery, which may explain why they were not detected in previous smaller and shorter studies.”
The Duke team compared two common techniques used to harvest saphenous veins that were used in 3,000 CABG surgery patients who were followed over a three-year period. Both techniques involve obtaining healthy saphenous veins from the leg, which are then used to create a blood vessel bypass around a blocked artery on the heart muscle.
The older method of making an incision along the leg and manually removing the vein has been widely replaced by the use of endoscopic devices that require only small incisions to remove the veins. The endoscopic devices eliminate the need for long incisions, reducing the risk of wound infection and other complications. Patients also commonly prefer endoscopic harvesting due to less pain and shorter hospital stays.
“One plausible explanation for our findings is that the endoscopic technique causes more trauma to the vein when it is removed, causing vein grafts to fail over time,” Alexander said. “Further work to refine endoscopic harvesting techniques and to enhance training and education may improve long-term outcomes.”
The researchers caution that more study is needed to better understand the implications of these findings. Patients in this study were not randomly assigned to vein harvesting technique. The harvesting technique was selected at the discretion of the surgeon.
Source: Duke University Health System, USA